I. Introduction
The Philippine National Health Account (PNHA) gives information on health care financing, provision, and consumption in the country. It provides data in determining whether the aggregate health care spending from all sources is adequate to meet basic requirements and identifies probable areas as inefficiencies in allocating health care resources.
The System of Health Accounts (SHA) 2011 provides a standard for classifying health expenditures according to three (3) axes: consumption, provision, and financing. It gives guidance and methodological support for the compilation of health accounts, which seeks to describe the health care system from an expenditure perspective both for international and national purposes. The SHA 2011 is the international standard for health accounting which presents a multi-dimensional approach to analyze the structure of the health system in a country.
II. Data and Data Sources
Health expenditure in the PNHA is compiled by component. Components generally correspond to financing agents (FA) or subcategories of FAs. The components have been primarily defined to correspond to expenditure core data sets. These are the same core data sources used in the previous version of PNHA. The succeeding notes describe the coverage, data sources, estimation methodology, and distribution keys of the health expenditures of PNHA.
| Financing Agent | Source Agency | Data/Publication/Report | |
|---|---|---|---|
| 1. | Central government | Commission on Audit (COA) | Annual Financial Report (AFR) of National Government, Government-Owned and/or Controlled Corporations |
| Financial Statements (FS) of the four (4) Specialty Hospitals (NKTI, LCP, PHC and PCMC) | |||
| Department of Budget and Management (DBM) | National Expenditure Program (NEP) | ||
| General Appropriations Act (GAA) | |||
| Budget of Expenditures and Sources of Financing (BESF) | |||
| Financing Agent | Source Agency | Data/Publication/Report | |
|---|---|---|---|
| 1. | Central government | DOH – Bureau of International Health Cooperation (BIHC) | Profile and Status of FAPs |
| National Economic and Development Authority (NEDA) | ODA Availments by Implementing Agency | ||
| 2. | State/Regional/Local government | COA | AFR of Local Government |
| FS of LGUs | |||
| DOF – Bureau of Local Government Finance (BLGF) | Statement of Receipts and Expenditures (SREs) | ||
| Health, Nutrition and Population Control by LGU Level | |||
| 3. | Social security agencies | COA | AFR |
| Philippine Health Insurance Corporation (PhilHealth) | Stats and Charts | ||
| Claims Database Tabulations | |||
| DBM | BESF | ||
| Government Service Insurance System (GSIS) | Statement of Claims and Benefits Paid · Employees Compensation Insurance Fund | ||
| Employees' Compensation Commission (ECC) | Benefit claims of SSS and GSIS that are for medical and rehabilitation services purposes | ||
| 4. | Insurance Corporations | Insurance Commission (IC) | Annual Report on Insurance Companies Financial data on insurance operations and health benefit payments |
| 5. | Corporations | IC | Annual Report on HMOs |
| Security Exchange Commission (SEC) | FS of HMOs | ||
| Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI) | FS of member HMOs | ||
| 5. | Corporations | COA | Annual Audit Report (AAR) |
| Philippine Charity Sweepstakes Office (PCSO) and Philippine Amusement and Gaming Corporation (PAGCOR) | Data on Health Expenditures | ||
| Philippine Statistics Authority (PSA) | Average expenditures per establishment by employment size and industry group from 2014 study of Racelis on private establishments health spending for employees | ||
| Philippine Statistics Authority (PSA) | National Accounts of the Philippines (NAP) · Data on private human health | ||
| 2018 Supply and Use Tables (SUT) | |||
Family Income and Expenditure Survey (FIES) Data on health and total expenditure | |||
| 6. | Households | PSA | NAP · Data on Household Final Consumption Expenditure (HFCE) Health |
On the distribution keys, the following data were used to classify the health care expenditures:
| Distribution Key | Source Agency | Report/Publication | |
| 1. | Distribution of the general population by income quintile | PSA | FIES |
| 2. | Distribution of total billing by: - age/sex - health care facility type | PhilHealth | PhilHealth Database |
| 3. | Distribution of contributions by schemes (government, private and individually-paying members | ||
| 4. | Distribution of benefit claims by: - Age and Sex - Region - Disease | PhilHealth | PhilHealth Database |
| 5. | Distribution of visits by disease | DOH | Field Health Services Information (FHSIS) |
| 6. | Distribution of employee and employer contribution | SSS and GSIS | Contribution Table |
| 7. | Distribution of primary and intermediate inputs | PSA | SUT |
III. Methodology
The PNHA based on SHA 2011 measures expenditures for the final consumption of health goods and services. It covers expenditures on activities with the primary purpose of improving, maintaining, and preventing the deterioration of health and mitigating the consequences of ill-health of individuals in the Philippines for a given year through the application of qualified health knowledge. The health accounts boundary is determined based on the following criteria: (a) primary purpose,
(b) use of qualified health knowledge, (c) expenditure for resident persons (spatial boundary), (d) expenditure incurred in a specified year (time boundary), and
(e) transacted (produced and paid for).Current Health Expenditure (CHE) and Health Capital Formation Expenditure (HK) are estimated as two (2) separate aggregates of PNHA.
Health expenditures are classified into schemes. The expenditure classifications under each of the three major dimensions of SHA 2011 are listed as follows:
| Dimension | Classification | |
|---|---|---|
| a. | Financing | Types of revenues of health financing schemes (FS) |
| Institutional units providing revenues to financing schemes (FSRI) | ||
| Health care financing schemes (HF) | ||
| Financing agents (FA) | ||
| Health care providers (HP) | ||
| b. | Provision | Factors of health care provision (FP) |
| Health capital formation expenditure (HK) | ||
| c. | Consumption | Health care function (HC) |
| Beneficiary characteristics | ||
There are health expenditure items that could not be classified into the given schemes above due to lack of details in the existing data. The disaggregation of these expenditure items is estimated using percentage distributions referred to as distribution keys. Distribution keys were prepared using data from research studies, statistical reports, administrative reports, censuses, surveys, and other data sources.
Health expenditures classified under the schemes mentioned above are reported and summarized in a series of two-dimensional tables.
| Component | Coverage | Estimation Methodology | |
| a. | National government (DOH) | These are the expenditures of the national government agencies for health-related activities funded by appropriations, with health activities identified based on agency mandate or activity descriptions. | Activities under DOH in the GAA or NEP are scaled up using the ratio of the agency-level expenses incurred stated in the AFR and agency-level programmed expenditure stated in GAA or NEP. In the estimation of the national government spending for the four (4) specialty hospitals, the Personnel Services (PS) and Maintenance and Other Operating Expenses (MOOE) reported in the Statement of Income and Expenditure are used. In the estimation of HK of the national government, actual health expenditure on capital outlays (CO) reported in the BESF are used. |
| b. | National government (non-DOH) | These are expenditures of other national government agencies whose mandates are entirely health-related (e.g., Food and Nutrition Research Institute (FNRI), Philippine Council for Health Research and Development (PCHRD), etc.); and expenditures of other government agencies identified as health-related based on stated purpose or description. | All health-related activities from identified government agencies in the GAA or NEP are scaled up using the ratio of the agency-level expenses incurred stated in the AFR and agency-level programmed expenditure stated in the GAA or NEP. In the estimation of HK of other national government agencies, actual health expenditures on CO reported in the BESF are used. |
| c. | Foreign-assisted projects (FAPs) | Expenditures (loans or grants proceeds) of all FAPs from foreign institutions which are intended primarily for health purposes. | Current health expenditures from foreign institutions are estimated using actual expenditures/disbursement of projects for a specific year as reported by DOH. Expenditures for health projects reported in the ODA report of NEDA but not listed in the DOH report are included. The amount is converted to Philippine Peso (PhP) using the exchange rate from the Bangko Sentral ng Pilipinas (BSP). FAPs reported in the BESF are used to validate and supplement the data from DOH and NEDA, as necessary. |
| d. | Local government | These are the expenditures of provincial, city, and municipal hospitals, as well as expenditures of LGUs for health, nutrition, family planning services, health governance, and general administration. | Health expenditures of provinces, cities, and municipalities are estimated by applying the health shares to the total expenditures of each level of LGUs reported in the AFR. The health shares are computed using SREs. The health expenditures from Health, Nutrition, and Population Control are divided by the total expenditures for each level of LGU. The expenditures for hospitals, health services (health centers), and general administration for health are estimated using detailed data from BLGF. |
| e. | Social security agencies (PhilHealth) | These are the benefit payments of PhilHealth and all its other expenses. | Data on claims or benefit payments for each type of PhilHealth Program based on Claims Database Tabulations are adjusted according to the totals by program as reported in the PhilHealth Audited Financial Statement or Annual Report. |
| f. | Social security agencies (Employees’ Compensation) | These are the claims or benefit payments from the Employees’ Compensation Insurance Fund (ECIF) of SSS and GSIS for the medical and rehabilitation services. | Benefit payments data for medical and rehabilitation services provided by ECC, GSIS and SSS are used as reported. |
| g. | Insurance corporations (Life and non-life insurance corporations) | These are the health benefit payments by both life and non-life insurance companies including the administrative costs attributed with health insurance activities. | Expenditures of private insurance companies for health and accident benefit payments are sourced directly from the IC Annual Report. General administration and operating costs of health and accident insurance activities are estimated by multiplying the proportion of health and accident premiums to the total general and other operating expenditures of the same company. |
| h. | Corporations (Other than insurance corporations) - Health maintenance organizations (HMOs) | Total expenditures of HMOs submitted to IC and SEC | Expenditures of HMOs for health benefit payments and for general administration are taken directly from the IC Annual Report. These are being supplemented by individual financial statements of HMOs. |
| i. | Government corporations | These are the expenditures for health care by PCSO and PAGCOR. The PCSO health expenditures include those of the Individual Medical Assistance Program (IMAP) and the Charity Clinic Department. The PAGCOR health expenditure includes subsidies for health (individual medical assistance and assistance to hospitals, NGOs and foundations), hospitalization (paid directly to hospitals), medical missions, wheelchairs, medical/laboratory equipment, and medicines. | |
| j. | Private corporations (Employee health care) | These are expenditures of private establishments for employee health care through, among others, (a) in-house provision of health care (personnel and other facility costs), (b) in-house provision of drugs and medicines, (c) cost of retained health care providers, and (d) fitness/health programs. | |
| k. | Households | These are the out-of-pocket expenditure of households for goods and services within the health accounts boundary. In FIES, these include the following: medicines, food supplements, curative and rehabilitative services, dental care, immunization services, diagnostic services, and other medical goods and services. | |
IV. Concepts and Definition of Terms
Beneficiary characteristics: The attributes of those who receive health care goods and services or benefit from health activities. There are four (4) classifications of characteristics in the PNHA. These include disease group, income quintile group, age and sex group, and region of residence.
Factors of health care provision (FP): The types of inputs used in producing the goods and services or activities covered by the health accounts boundary.
Financing agents (FA): Institutional units that manage health financing schemes.
Health care financing schemes (HF): Components of a country’s health financial system that channel revenues received and use those funds to pay for, or purchase health care goods, services, and activities.
Types of revenues of health financing schemes (FS): The revenues of the health financing schemes received or collected through specific contribution mechanisms.
Health capital formation expenditure (HK): The type of assets that health providers have acquired during the accounting period and that are used repeatedly or continuously for more than one year in the production of health services; memorandum items (HKR) reported under the capital formation account include health research and training.
Health care functions (HC): The types of goods and services provided and activities performed within the health accounts boundary.
Health care providers (HP): Entities that receive money in exchange for, or in anticipation of producing the activities inside the health accounts boundary.
Institutional units providing revenues to financing schemes (FSRI): Institutional units that provide revenues to health financing schemes (a “Reporting Item” or RI under the Financing Sources or FS dimension).
V. Dissemination of Results and Revision
The schedule of release of PNHA is eight (8) months after the reference period. A press release, publication, statistical tables, and infographic are posted on the PSA website.
VI. Citation
Philippine Statistics Authority. (2024). Technical Notes on Philippine National Health Account. https://psa.gov.ph/statistics/pnha/technical-notes
VI. Contact Information
Mr. Gerald Junne L. Clariño
Chief Statistical Specialist
Satellite Accounts Division
g.clarino@psa.gov.ph
For data request, you may contact:
Knowledge Management and Communications Division (02) 8462-6600 locals 839, 833 and 834
info@psa.gov.ph
